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Critical Appraisal

Critical Appraisal

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Critical Appraisal

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  1. Critical Appraisal CARA EFEKTIF BELAJAR SEPANJANG HAYAT Dr. Ariani RD.,SpM. FK Unisma Malang. 2011.

  2. The Problem 1 • Vast and expanding literature. • Limited time to read. • Different reasons to read : • Keeping up to date. • Answering specific clinical questions. • Pursuing a research interest.  mean different strategies

  3. Stages 2 • Clarify your reasons for reading. • Specify your information need. • Identify relevant literature. • Critically appraise what you read.

  4. Clarify Your Reasons for Reading 3 • Keeping up to date. • Skimming the main journals and summary bulletins. • Answering specific clinical questions. • Finding good quality literature on subject. • Pursuing a research interest. • Extensive literature searching.

  5. Specify Your Information Need 4 • What kind of reports do I want? • How much detail do I need? • How far back should I search? The answers to these questions should flow from the reasons for reading.

  6. Kind of Reports 5 Study Types for Question Types ...Specify Your Information Need

  7. .Identify Relevant Literature 6 • There are many ways of finding literature. • Selectivity is the key to successful critical appraisal.

  8. Ways of Finding Literature 7 • Source of Medical Information • Colleagues • Conferences • Drug Reps • Textbooks • Journals • Internet/Patients ...Identify Relevant Literature

  9. Keeping Up to Date 8 • Daily InfoPOEMs http://www.infopoems.com/ • bmjupdates+ http://bmjupdates.mcmaster.ca/index.asp • Tables of contents of journals (e.g. JAMA) • From journal itself • My NCBI from PUBMED ...Identify Relevant Literature

  10. Clinical Question - Research 9 • EBM Databases • MEDLINE • Free online access thru PubMed • www.ncbi.nlm.nih.gov/entrez/ • Search by MESH terms or free text • EBM Filters ...Identify Relevant Literature

  11. Selectivity 10 • Filters for Medline Search • Diagnosis • Sensitivity and Specificity • Treatment • Randomized controlled trial • Blind or Double Blind ...Identify Relevant Literature

  12. Critically Appraisal What You Read 11 E B M

  13. Evidence-Based Medicine 12 What is EBM ? Why do it ? ...Critically Appraisal What You Read

  14. What is EBM ? 13 "...the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.“ from Sackett, DL, et al. "Evidence based medicine: What it is and what it isn't." (BMJ 1996; 312: 71-2) ...Critically Appraisal What You Read

  15. What is EBM ? 14 An approach to clinical decision-making in which one searches the literature, critically evaluates the research evidence, and then chooses the most appropriate interventionor course of action to take. ...Critically Appraisal What You Read

  16. Why do EBM ? 15 APPLICATION TO PRACTICE • Increase patient trust • Provide best possible care • Reduce liability risk ...Critically Appraisal What You Read

  17. What a Physician can be Faced With on a Daily Basis? 16 • ~1 - 2 questions per patient (clinics) • 15/patient/day (wards) • 40% easy to answer • 30% tough to answer • 30% cannot answer Source: Dawes M, Sampson U. Knowledge management in clinical practice: a systematic review of information seeking behaviour in physicians. Int J Med Inform. 2003 Aug; 71(1):9-15. Review. PMID: 12909153 ...Critically Appraisal What You Read

  18. Critical Appraisal of Literature 17 Intended to enhance the clinician’s skill to determine whether the results reported in an article were likely to be . . . . . . . true . . . important . . . applicable to their patients! ...Critically Appraisal What You Read

  19. Why Should we Critically Appraise? 18 • Published research is not always reliable • Published research is not always relevant • To improve clinical effectiveness, we need a systematic framework to interpret research ...Critically Appraisal What You Read

  20. Difficulties with Critical Appraisal 19 • Can be time consuming initially • Doesn’t provide an “easy” answer • It could show a lack of good evidence in a particular topic ...Critically Appraisal What You Read

  21. How can we do Critical Appraisal? 21 • Use common sense • Use simple checklists • Use different checklists depending on the different types of studies (i.e., RCTS, systematic reviews etc) • Checklists help you focus on the important parts of the article ...Critically Appraisal What You Read

  22. Checklists 22 • Quick and easy • 3 stages: • Basic questions. • Essential appraisal. • Detailed appraisal. ...Critically Appraisal What You Read

  23. 1st. Basic Questions. ...Critically Appraisal What You Read

  24. How to Read a Research Article? – First Glance. 24 • Purpose of reading the paper. • Do not read the abstract. • Read the title, find out who the authors are and where they work, look for sources of funding and conflicts of interest • Look at the tables and figures • Is there a diagram to show the flow of participants through each stage of the study • Why was the study done and what hypothesis were the authors testing? • What is broadly the topic of research? • Therapy, Diagnosis, Screening, Prognosis, Causation? • What type of study was done? • Is this a primary (experimental, clinical trial, survey) or a secondary paper (review, meta-analysis, guideline)? ...1st. Basic Questions.

  25. PICO Structure 25 • Patient or problem • Intervention • Comparison • Outcome ...1st. Basic Questions.

  26. 2nd. Essential Appraisal. ...Critically Appraisal What You Read

  27. EBM “simplified” approach 27 • What are the results? • Are the results valid? • Will the results help me in patient care? ...2nd. Essential Appraisal.

  28. KEY QUALITY PARAMETERS 28 • VALIDITY • RELIABILITY • IMPORTANCE ...2nd. Essential Appraisal.

  29. VALIDITY 29 • INTERNAL Is the study designed in such a way that I can trust the findings? • EXTERNAL Is the study designed in such a way that I can generalize the findings? ...2nd. Essential Appraisal.

  30. RELIABILITY 30 If the study was conducted again, would the results be the same? Usually interpreted as the accuracy of measurement. ...2nd. Essential Appraisal.

  31. Validity and Reliability 31 • A test is valid when it measures what it’s supposed to. • If a test is reliable, it yields consistent results. • A test can be both reliable and valid, one or the other, or neither. ...2nd. Essential Appraisal.

  32. Reliable, but Not Valid! ...2nd. Essential Appraisal.

  33. Not Reliable, Not Valid! ...2nd. Essential Appraisal.

  34. Reliable and Valid ...2nd. Essential Appraisal.

  35. IMPORTANCE 35 What was the effect size or magnitude of effect? Clinical vs. statistical significance. ...2nd. Essential Appraisal.

  36. 3rd. Detailed Appraisal. ...Critically Appraisal What You Read

  37. Dasar-Dasar Metodologi Penelitian Klinis Edisi ke-2 Prof. DR. Dr. Sudigdo Sastroasmoro, Sp.A (K) Prof. Dr. Sofyan Ismael, Sp.A (K) Jakarta 2002

  38. Deskripsi Umum 38 • Desain apakah yang digunakan • Manakah populasi target, populasi terjangkau, sampel • Bagaimanakah cara pemilihan sampel • Manakah variabel bebas • Manakah variabel tergantung • Apakah hasil utama penelitian Tabel 21-2. Telaah Kritis Makalah Kedokteran : Hal-hal yang dinilai pada studi hubungan sebab-akibat. Sastroasmoro, Sudigdo (2002)

  39. Validitas Interna, hubungan non-kausal 39 • Apakah hasil dipengaruhi bias • Apakah hasil dipengaruhi faktor peluang • Apakah observasi dipengaruhi perancu Tabel 21-2. Telaah Kritis Makalah Kedokteran : Hal-hal yang dinilai pada studi hubungan sebab-akibat. Sastroasmoro, Sudigdo (2002)

  40. Validitas Interna, hubungan kausal 40 • Apakah hubungan waktu benar • Apakah asosiasi kuat • Apakah ada hubungan dosis • Apakah hasil konsisten dalam penelitian ini • Apakah hubungan bersifat spesifik • Apakah ada koherensi • Apakah hasil biologically plausible Tabel 21-2. Telaah Kritis Makalah Kedokteran : Hal-hal yang dinilai pada studi hubungan sebab-akibat. Sastroasmoro, Sudigdo (2002)

  41. Validitas Eksterna 41 • Apakah hasil dapat diterapkan pada subjek terpilih • Apakah hasil dapat diterapkan pada populasi terjangkau • Apakah hasil dapat diterapkan pada populasi yang lebih luas Tabel 21-2. Telaah Kritis Makalah Kedokteran : Hal-hal yang dinilai pada studi hubungan sebab-akibat. Sastroasmoro, Sudigdo (2002)

  42. Desain Penelitian 42 Deskripsi Umum

  43. Desain Penelitian

  44. Desain Penelitian

  45. Desain Penelitian

  46. Desain Penelitian

  47. Desain Penelitian

  48. Populasi 48 Deskripsi Umum

  49. Populasi 49 Deskripsi Umum

  50. Sampel 50 Karakteristik Subjek Penelitian  = pasien kita ?  Dapat kita terapkan ? Deskripsi Umum